fame study ffr vs angiography for multivessel evaluation

FAME StudyFFR vs Angiography for Multivessel Evaluation

Does measuring FFR really make a difference?

FAME is a large, randomized, controlled, multicenter trial comparing stent treatment guided by FFR versus angiographic guidance alone

The FAME study was designed to reflect the daily practice of performing PCI in patients with multivessel disease

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Study Design

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Key Inclusion and Exclusion criteria Inclusion criteria:

- Patients with multivessel disease- At least 2 stenoses greater than or equal to 50% in 2 or 3 major

epicardial coronary artery vessels, amenable to stenting

Exclusion criteria:

- Left main disease or previous bypass surgery- ST-elevation MI with CK greater then 1000 U/l within last 5 days- Extremely tortuous or calcified coronary arteries

Note: patients with previous PCI were not excluded

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Endpoints Primary Endpoint

Composite of death, myocardial infarction, or repeat revascularization (“MACE”) at 1-year

Secondary Endpoints

- individual components of MACE at 1-year- functional class- use of anti-anginal drugs- health-related quality of life (EuroQOL-5D)- procedure time- amount of contrast agent used during procedure- cost of the procedure

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Participating Sites

Fourteen European centers and six United States centers enrolled more than 1,000 patients in the FAME Study

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Study Enrollment and Randomization

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Assessed for eligibilityN=1905

Angiography guided PCIN=496

FFR guided PCIN=509

Lost to follow-upN=11

Lost to follow-upN=8

AnalyzedN=496

AnalyzedN=509

RandomizedN=1005

Were not eligible N=900Left main stenosis N=157

Extreme coronary tortuosity or calcification N=217

Did not provide informed consent N=86

Participation in other study N=94Logistic reason N=210

Other reason N=31

Baseline Characteristics

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Similar characteristics in the two groups

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Baseline Characteristics (cont’d)

Results

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Significant difference between the two

groups

Endpoints

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Results One-year Follow-up

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FAME: - proof that measuring FFR

during the stenting procedure really does make a difference...

Results One-year Follow-up

...there is a reduction in MACE: 28%

less risk of dying, having a heart attack or having to come back for more stents or a bypass operation

...there is a reduction in death or MI: 34%

less risk of dying or having a heart attack

Summary:

Better outcomes... AND it significantly SAVES on costs AND it doesn’t prolong the procedure.

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Sub-analysis – Angiographic vs Functional Severity

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65% 20% 4%

35 %

Tonino P. A. L et al; J. Am. Coll. Cardiol. 2010;55;2816-2821

Results 2-year Follow-up

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Significant difference in MI and MI/death between the two groups


2-year Survival from Death and MI

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Results Two-year Follow-up

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Significant difference in MI and MI/death between the two groups

2-year Survival from Death and MI

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Outcome of Deferred Lesions

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513 Deferred Lesions in509 FFR-Guided Patients

53 Repeat Revascularizations

16Originally Deferred Lesions

10Originally Deferred Lesions

with Clear Progression

37in a New or Restenotic Lesion

6Without FFR or

Despite an FFR > 0.80

Only 10/513 or 1.9% of deferred lesions clearly progressed requiring repeat revascularization

2-years

William F. Fearon et al, on behalf of the FAME Study Investigators. Presented at TCT “==)

Outcome of Deferred Lesions

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513 Deferred Lesions in509 FFR-Guided Patients

31 Myocardial Infarctions

9Late Myocardial Infarctions

1Myocardial Infarction due to

an Originally Deferred Lesion

22Peri-procedural

8Due to a New Lesion

or Stent-Related

Only 1/513 or 0.2% of deferred lesions resulted in a late myocardial infarction

2-years

William F. Fearon et al, on behalf of the FAME Study Investigators. Presented at TCT “==)

2-year follow-up:Better Outcomes at Lower Costs

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Measuring FFR using St Jude Medical’s PressureWire improves patient outcomes up to 2-years post procedure and reduces procedural and healthcare costs without prolonging procedure time.

Results Two-year Follow-up

At 2-years a significant decrease in the rate of MI in the FFR-guided arm is demonstrated.

There continues to be a significant decrease in death and MI favoring the FFR-guided approach.

There is a strong trend toward a lower rate of death, MI or the need for repeat revascularization in the FFR-guided arm.

There is no sign suggesting that deferred lesions are likely to be responsible for late myocardial infarctions or to progress and require repeat revascularizations.

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Rx Only

Please review the Instructions for Use prior to using these devices for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use.

Product referenced is approved for CE Mark.

PressureWire is designed, developed and manufactured by St. Jude Medical Systems AB. PressureWire, RADI, ST. JUDE MEDICAL, the nine‐squares symbol and MORE CONTROL. LESS RISK. are registered and unregistered trademarks and service marks of St. Jude Medical, Inc. and its related companies.

©2011 St. Jude Medical, Inc. All rights reserved.

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fame study ffr vs angiography for multivessel evaluation

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